Provider Demographics
NPI:1326312026
Name:DAVIS, CHRISTOPHER WAYNE (NP-C)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:WAYNE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4560 LAKE RIDGE PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-1707
Mailing Address - Country:US
Mailing Address - Phone:972-522-7778
Mailing Address - Fax:972-522-7779
Practice Address - Street 1:4560 LAKE RIDGE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-1707
Practice Address - Country:US
Practice Address - Phone:972-522-7778
Practice Address - Fax:972-522-7779
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX777567163W00000X
TXAP122022363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse